Can Obama Solve America's Health Care Crisis?

Universal coverage is just the beginning—we need safer hospitals, electronic medical records, and dozens more improvements to our antiquated system.

Like millions, I recently watched a late-night televised appearance by Bill Clinton and Barack Obama. They were speaking in Kissimmee, Florida, of all places—not too far from where I grew up and nourished plans to become a doctor even though I can only recall seeing the doctor once, when I broke my arm in junior high. (It was set badly. For much of my childhood, our family of eight went without health insurance.) Along with tens of millions, I’d watched campaign coverage veer from one topic to another, with pundits finally agreeing that an economy in free-fall was Issue Number One. No argument that night and on that score, from either past president or soon-to-be president-elect. But what about health care? When asked in a debate if health care is a privilege or a right, Obama did not hesitate. A right, he answered, reflecting on his dying mother’s humiliating skirmishes with her insurers. For McCain, and in the current system, health care is a commodity you shop for and buy.

Patients and providers and employers alike need a new New Deal. And it looks like we might just have a Rooseveltian visionary—pragmatic, bold—headed to Pennsylvania Avenue.

It’s a mistake to think of health care as distinct from Issue Number One. The health-care crisis—and that’s what it is—is a big part of the economic challenge facing a country that we’re now told is entering a recession. Like most doctors, I don’t know enough about health-care financing, but I do know this: with outlays like those registered in the United States, surely we should have universal coverage. Surely we should have a more effective, more modern, way of improving both our hospitals and clinics. Surely we should have a safer system. (Quick: what is the eighth-leading cause of death in the United States? Medical error.) With his inimitable style and Dickensian eloquence, President Clinton put it this way: as regards health care, he said, “you’ve been sold out to a fare-thee-well.”

So we have. We spend more than any other nation on health care—now pushing 17% of the GDP, almost twice what is spent in Britain and other affluent democracies—and get less return on our investment. We compare unfavorably, in terms of health outcomes, with almost all the other industrialized nations. The most disturbing fact is that, despite huge differences in costs from one state to another, there isn’t a correlation between is the amount spent and health outcomes: an extra few thousand dollars per capita doesn’t buy us much of anything. Employers, responsible for the majority of insurance, are looking to dodge their obligations, grumbling that they can’t compete in the global economy because of the rising costs of health care.

Patients and providers and employers alike need a new New Deal. And it looks like we might just have a Rooseveltian visionary—pragmatic, bold—headed to Pennsylvania Avenue. Not a moment too soon.

I am writing this from central Haiti, where I’m a volunteer doctor, but last Tuesday night I was in Boston, glued to the tube. I was with friends, including medical colleagues, almost all of them Americans and most of us die-hard Obama supporters. We had a guest from the U.K., Sir Brian Jarman, a general practitioner from London. The honorific derives almost certainly from his long support of, and participation in, the National Health Service—that vaguely redistributive (or as some would allege, socialist) plot to provide a medical safety net to all Britons. I invited Jarman, who is visiting as a guest of the Institute for Healthcare Improvement (IHI), to come to the classes I teach with a great American doctor, Jim Yong Kim, at Harvard. (Full disclosure, as print journalists often goofily add: Jim is my best friend from medical school. We’ve worked together for over 20 years and founded, along with others, Partners In Health, which provides health care to the poor in ten countries, including Haiti, Rwanda, and the United States.) Jim and I had invited the founder of IHI, Dr. Don Berwick, to address our class and we thought it would be a good idea to have Sir Brian meet the students, too. The students are concerned about the future of health care and about their chances of being effective practitioners in a system that, in spite of its highs and lows, is broken. As physicians-in-training concerned about health-care costs, efficiency, coverage, and safety, these students have been sold out to a fare-thee-well, too. They’re not opposed to bold change. Although we often read about the medical profession’s opposition to national health insurance, I almost never encounter it among my students.